Cardiology
Expert discussions on heart failure, arrhythmias, interventional procedures, and cardiovascular risk management.
Recent Discussions
Should CT coronary calcium score be avoided in dialysis patients in light of presumed high prevalence of CAC in this population?
The incidence of coronary calcifications in patients on dialysis exceeds 80% and is between 50-80% in patients with CKD. In addition, dialysis and ESRD cause two types of vascular calcification - in the medial and intimal layers, the latter being the one that correlates best with atherosclerotic pla...
Are there any heightened risks for cardioversion following a recent PCI from a stent patency standpoint or hemodynamic concerns?
Most of our concerns about procedures soon after PCI revolve around the issue of anticoagulation. In this case, as long as the patient could receive an anticoagulant while on antiplatelet therapy (at a somewhat increased risk of bleeding), a cardioversion is possible. Though there is a hypothetical ...
How do you manage asymptomatic non-sustained atrial arrhythmia in patients with single ventricle and Fontan physiology?
This is an excellent, challenging question and I think experts will disagree and debate the issue depending if they are risk-minimizers or cost-minimizers and if patients are worriers (woulda, coulda, shoulda) or data-driven/evidence-based (need to see large studies with proof before action).I like ...
What cardiac testing do you perform for patients undergoing liver transplant evaluation?
Each institution I am aware of has slightly different approaches to cardiac testing for transplantation candidacy. In our institution, we have patients undergo a TTE with a bubble study at a minimum. However, patients with any risk factor for coronary disease will undergo coronary angiography (CT or...
When do you recommend screening patients with T2DM for heart failure?
Screening patients with T2DM for heart failure is recommended at the time of diagnosis. This recommendation is based on the increased risk of HF in this population, even in the absence of symptoms. The American Diabetes Association guidelines recommend that screening for asymptomatic heart failure i...
How do you choose between finerenone and traditional steroidal MRAs for patients with heart failure and mildly reduced or preserved EF, considering recent results showing finerenone's efficacy in reducing heart failure events?
Not only is cost coverage important, with reduced rates for commercial, but not Medicare/Medicaid pts, but the expected reduced adverse drug effect profile of finerenone over spironolactone or eplerenone. That is relevant when treating men with borderline hyperkalemia.
In patients with moderate calcific mitral stenosis, possible HFpEF and dyspnea on exertion, how would you differentiate the etiology of the symptoms?
I would consider a dobutamine stress echocardiogram to evaluate the flow across the valve as well as diastolic parameters. If this does not answer the question, an exercise right heart catheterization could be helpful and could also look into concomitant pulmonary hypertension as a cause of dyspnea....
How soon after an elective, uncomplicated coronary intervention would you feel comfortable having a patient travel by air?
Usually, 3-5 days after uncomplicated PCI. But in the era of transradial and 5-fr sheaths, and in the absence of Sx, with preserved LV EF, this may be truncated to 48 hours.
Would you make any dialysis prescription modifications for an ESKD patient who develops tachycardia during a hemodialysis session?
Arrhythmias that initiate during dialysis treatment are almost always due to hypokalemia. Unfortunately, changing the potassium bath after an arrhythmia has already started will likely not help. The answer to the question depends on the circumstances of the patient. If unstable, would stop dialysis....
Is azilsartan superior to other angiotension receptor blockers in regard to cardiorenal outcome data?
In short, there are no data. There are very few head-to-head comparisons of ARBs on hard outcomes. Azilsartan was used in SPRINT (alongside losartan and valsartan), though the secondary analyses focused on class effect as opposed to specific med-to-med comparisons within a class (DeCarolis et al., P...